Gulag Blog

Letter: The Japanese ‘Love Getting MRIs’

Michiko writes:

As a practicing neurologist in private practice, I have many thoughts related to the current health care debate, and I decided to write to you about the most recent podcast, on “the price of MRI“. I am Japanese and graduated medical school, and trained in Japan at Kyoto University. I then moved to New York City in the late 90’s, and trained as a neurologist at New York Hospital/Cornell Presbyterian Medical Center and the National Institute of Health (NIH). I now have a private practice in Honolulu, Hawaii.

As a neurologist, I order many MRIs every day. I am frequently enticed by the multiple free standing MRI centers, to order scans at their facility. They offer free pastries for the staff, holiday gifts, and free lunch/dinners. They also have state of the art machine (3T vs 1.5T), ability to do new protocols, movie goggles while patients are getting there scan, spa quality changing room, bathrooms and sometimes water and cookies for the patient while they wait. However, I still order most of my MRIs through the medical center where I practice, or few other facilities, based on what you did not talk about, and that is quality of the “reading” (i.e. radiologist’s input).

This is not quality of the “scan” that you mentioned in your piece. I do look at the scan myself, so the quality of the scan itself is important, but my working relationship with the radiologist is of paramount importance. If there is question about the study, I will call them up, and discuss the case. Some of the free standing MRI facilities do not have a reading radiologist on site — they are outsourced to radiologist, often on the mainland. It is often shift working radiologist who is reading large number of scans from multiple facilities, who have no investment in my patients, and are often not available to discuss the readings. This is an important non-economic reason why I use my medical center’s MRI facility.

We have community of physicians involved in the care of neurological patients. This team include neurologist of many different subspecialties, neurosurgeons, neuroradiologists, radiation oncologists, neuropsychologists, and physical therapists. The formal and informal discussions we have about our patients is not available at free standing facilities, where there is an emphasis on volume and efficiency of imaging, vs actual patient care.

On your show, you asked why the price of MRI is lower in Japan. I believe this to be mutifactorial. First, radiologist salaries are much lower than in the US. (Physicians generally have lower salaries in Japan, but higher social status, and lower malpractice concerns.) Second, Japan has a more comprehensive government sponsored health care system, which allows government to set price in a more autocratic way. A good example of this was that the reimbursement of MRI was lowered by the government in 2002 by more than 30 percent, because of cost concerns related to over utilization. Japanese, even more than Americans, love getting MRIs.

An interesting unintended consequence of lower reimbursement for MRIs has lead MRI centers to begin direct marketing to consumers to presumably make up for decreased reimbursement rates. MRI centers now offer studies that do not even require a physician order, if patients pay cash.

This is part of a movement in Japan, where people go outside of the conventional insurance based health care system, and pay cash for technically advanced preventative screening. These diagnostic centers offer blood work, EKG, stress test, X-ray, MRI, endoscopy and colonoscopy. There is no good evidence that this type of comprehensive diagnostic screening improves individual or public health, but many Japanese people are willing to pay for this type of service. I was looking at a few Japanese websites today, and I found a number of sites encouraging you to have brain MRI screening as frequently as twice a year, for $400-$800.

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